Adoption Application

Adoption Application

You must be 18 or older to adopt a pet
General Information
Full Name*

First NameLast Name
Date*

MonthDayYear
PA driver's license #*
Phone number*

Area CodePhone Number
Pet's name or description of pet*
Email Address
Are you or your spouse currently employed?*

YesNo
Employer's Name*
Employer's Phone Number*

Area CodePhone Number
Home Information
Current Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Time at this Address*
Rent or Own?*

RentOwn
Home Owner Must Provide One of the Following:*
Landlord's Name*
Landlord's Phone Number*

Area CodePhone Number
How many people live in your home?*
Please list their name(s) and ages including yourself*
Does your home have a yard?*

YesNo
Is your yard fenced in?*

YesNo
Describe fence height/material:*
Traffic near home:*
Pet History
Do you currently own, or in the last five years have owned any pets?*

YesNo
Veterinarian's name:*
Veterinarian's phone number:*

Area CodePhone Number
Which pets do you own?*

One DogOne CatMultiple DogsMultiple CatsOther
Please specify:*
Are your pets spayed/neutered?*

YesNo
Have you adopted from a rescue organization before?*

YesNo
Which organization?*
Have you ever turned a pet over to a humane society/organization?*

YesNo
Please explain why:*
Adoption Information
Where will the pet spend it's days/nights?*
About how many hours per day will somebody be home?*
If your pet is not house broken, chews things up, etc., how do you plan to correct the behavior?*
Legal Information
Why are you interested in adopting a pet?*
Are you aware of any state laws pertaining to pet ownership/care?*

YesNoSomewhat
When is a good time for a home visit? (All members need to be present)*
References

Please do not use family members/relatives
Reference #1:*

First NameLast Name
Phone*

Area CodePhone Number
Reference #2*

First NameLast Name
Phone*

Area CodePhone Number
All Finished!
By typing your full first and last name below, you are certifying that the above information is true and accurate to the best of your knowledge.
Full Name*

First NameLast Name
Should be Empty:

Adoption Application

General Information

Home Information

Pet History

Adoption Information

Legal Information

References

All Finished!